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Even if website works, Obamacare could see trouble ahead

WASHINGTON (Reuters) – The Obama administration says it is on target to make its problematic health insurance website work smoothly for the “vast majority” of users by this weekend, but some Americans who want coverage by Jan. 1 may not be able to get it – even if they successfully navigate the portal and sign up for a plan.

The problem, according to insurance industry officials and other specialists, is that the administration is behind schedule in building a computer program needed to help insurers verify the names, insurance plan choices and other details of those who sign up for health coverage under the Patient Protection and Affordable Care Act, known as Obamacare.

The computer program – which administration officials acknowledge will not be finished until sometime next year – is among several crucial pieces of administrative technology the government is devising to serve new online healthcare marketplaces that allow people to purchase subsidized private health insurance or join the Medicaid program for the poor in all 50 states.

The missing technology includes a computer program to make sure government subsidies to help low-income enrollees pay for coverage get to insurers.

The programs under construction are part of a complex federal technology system that is crucial to the new health system’s goal of helping millions of uninsured and under-insured Americans sign up for coverage through HealthCare.gov and other websites.

The online marketplaces opened for enrollment on Oct. 1 but have been beset by technical problems, particularly with HealthCare,gov, the federally run website that serves consumers in 36 states.

Even if HealthCare.gov is able finally to handle the flood of enrollees that officials expect in December, the administration could face a backlash from people who have enrolled but whose paperwork will not be completed by the time their coverage is supposed to take effect on January 1.

Significant new difficulties would hinder efforts by President Barack Obama and his Democratic allies to show they have dealt with the botched rollout of the healthcare overhaul.

It also could create a new narrative for Republicans, who have argued for the healthcare law to be delayed or killed and will be looking to focus on Obamacare’s troubles going into next year’s mid-term elections.

‘COVERAGE COULD BE DISRUPTED’

Until the administrative computer programs are finished, information about some Obamacare enrollees could be incomplete or inaccurate by the time insurers receive it from the exchanges, analysts said.

“This is a significant issue,” said Dan Mendelson, a healthcare specialist who worked in the White House Office of Management and Budget during the Clinton administration.

“People could wind up going to the doctor or the hospital, thinking they’re enrolled, when they may not be,” said one insurance industry official, who asked not to be identified because he did not want to comment publicly.

It is not clear how many people could be affected.

But in a system that could eventually have about 7 million people enrolled for 2014, the potential for inaccurate information spans the 36 states served by the federally run HealthCare.gov and the 14 states with their own insurance marketplaces, all of which rely on the same technology for administrative functions.

“If … the ongoing back end challenges are still not resolved, the enrollment process may not be completed and consumers’ coverage could be disrupted,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, an industry trade and lobbying group.

Consumers “will forgive some start-up issues with the ability to enroll on the website,” said Gregory Nersessian, principal with consulting firm Health Management Associates.

Nersessian said, however, that “it’s going to be far more damaging if their information and their expectation about enrollment and payment and coverage get confused because of the back end system.”

Government officials acknowledge that completing the computer program at the administrative end is necessary to ensure accurate enrollment.

But in recent weeks they have focused more on fixing the “front end” of Obamacare consumers see: the HealthCare.gov website that allows people to enroll in the program.

Those wanting health coverage by Jan. 1 initially had until Dec. 15 to enroll, but the website’s problems led the administration to extend that deadline to Dec. 23.